Microbiological quality of probiotic products

Microorganisms used as probiotics should meet elementary safety aspects (non-toxicity, absence of antibiotic resistance genes and translocation) and functional/technological aspects (resistance and survival in the acid gastric environment, adhesiveness, stability, and cell viability). Probiotics with the health claim of being a dietary product or a pharmabiotic (drug category) should be clinically tested, validated, documented, and continuously controlled for quality. Important quality parameters include the identification of declared probiotic strains, the number of viable microorganisms (probiotic bacteria and/or fungi), and microbiological purity (absence of specified pathogenic/opportunistic pathogenic bacteria and fungi, and limitation of total unspecified contaminants such as aerobic bacteria, yeasts, and molds). Due to numerous reports of low-quality commercial probiotics marketed for human use, this review discusses the methods used to test the probiotic microorganism content, safety for the intended use, and proven health benefits of those probiotics whose microbiological quality deviates from the manufacturer's stated content, as well as the maintenance of cell viability, i.e., stability of the probiotic during the shelf life. In addition, the adverse effects of probiotics and the potential hazards to the health of the user are addressed

Pituitarni apsces neuobičajenog kliničkog tijeka

The aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of inflammatory markers. The presence of expansile sellar lesion, showing restricted diffusion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confirmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fibrotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic inflammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic inflammatory changes with granulation tissue proliferation, mimicking macroadenoma.Cilj rada je prikaz neuobičajenog kliničkog tijeka i magnetsko-rezonantnih (MR) karakteristika pituitarnog apscesa. Bolesnik je bio 59-godišnji muškarac s groznicom, poliurijom, polidipsijom i gubitkom tjelesne mase u posljednja dva mjeseca. Osnovni endokrinološki testovi ukazali su na poremećaj funkcije adenohipofize, udružen s centralnim insipidnim dijabetesom i povišenom razinom upalnih biljega. Pregled pomoću MR je otkrio ekspanzivnu leziju u selarnoj regiji sa znacima restrikcije difuzije, nalaz kompatibilan s pituitarnim apscesom. Nakon primjene antibiotika tijekom sljedećih nekoliko tjedana došlo je do regresije apscesa, a odgovarajuće nadomještanje hormona postignuto je primjenom L-tiroksina, hidrokortizona, testosterona i dezmopresina. Sedamnaest mjeseci kasnije uočeno je pogoršanje kliničkog stanja s opetovanim pituitarnim apscesom, što je potvrđeno pomoću MR. Nakon primijenjene terapije došlo je do ponovne regresije apscesa. Međutim, kontrolni pregled pomoću MR tri godine nakon prvog otkrio je prisustvo pituitarnog tumora s obilježjima makroadenoma, zbog čega je provedena kirurška intervencija. Patohistološka analiza je dokazala prisustvo fibroze udružene s granulacijskim tkivom, rijetkim staničnim elementima, karakteristično za kroničnu upalu. U literaturi ne postoje studije koje prikazuju kroničnu evoluciju pituitarnog apscesa s kroničnim upalnim promjenama koje oponašaju makroadenom

Beneficial effects of probiotic supplementation on glucose and triglycerides in a mouse model of metabolic syndrome

The present study aimed to examine the effect of Lactobacillus rhamnosus Rosell 11 and Lactobacillus helveticus Rosell 52 on glucose (blood level and tolerance), lipids (cholesterol and triglycerides), transaminases (AST and ALT), ALP, urea, and creatinine, along with body weight, food intake, liquid consumption, and gross pathology in a mouse model of metabolic syndrome. Male C57BL/6J mice were fed a high-fat high-sucrose diet and treated by oral gavage with a probiotic mixture in three different concentrations (107, 108, and 109 CFU/mL) once daily for 2 months. Probiotic supplementation, particularly at a concentration of 109 CFU, significantly decreased blood glucose and serum triglyceride levels, improved glucose tolerance, and promoted body weight loss in mice fed a high-fat high-sucrose diet. According to the obtained results, probiotic supplementation is useful for controlling glucose and triglyceride levels and could be used as an adjunctive therapeutic approach in patients with metabolic syndrome

The quality of life in patients with diabetes mellitus type 2

Background/Aim. Through its various activities, World Health Organization (WHO) contributed to increasing the understanding of the concept of quality of life. People with diabetes have a lower quality of life than people without chronic illnesses. The aim of this study was to examine the differences in the quality of life, related to health, in patients with diabetes mellitus (DM) type 2 by age, gender and type of therapy. Methods. We performed a cross-sectional study at the outpatient department of the Clinical Center in Novi Sad and the Health Center Ruma - General Practice. The group consisted of 90 patients with DM type 2, 41 men and 49 women. The age of respondents was from 40 to 80 years and they were classifed into four groups according to the ten-year age intervals. We applied WHO Quality of life questinnaire - BREF 100 composed of four domains: physical health, psychological health, social relationships and environment. The general questionnaire asks questions about socio-demographic data, duration of diabetes, the last value of blood glucose and glycosylated hemoglobin, training for self-control and its implementation, informing patients about their disease, therapy and its impact on daily activities and the presence of comorbidity. In statistical analysis the following tests were used: Student’s t-test, Ftest, ANOVA (one way). Results. The average duration of DM type 2 was 11.2 ± 9.2 years. Most of the patients (76%) were trained to self-control and 91% received enough information about their disease. Oral hypoglycemic preparations were used by 49%, insulin by 21%, and oral drugs and insulin by 29% patients while 1% were on a special regime of a diet therapy. Daily activities were performed without difficulties by over 29%, with some difficulties by 41% and 30% of patients who could not perform daily activities. The patients with DM type 2 had significantly lower scors in all 4 domains of quality of life (physical health, psychological health, social relations, environment). The biggest influence was on physical domains (51.31). Education level had an impact on physical and psychological domains. Comorbidity was found in 83% of the respondents. The most common were: arterial hypertension (63%), chronic cardiovascular disease (46%), neuropathy (23%), impaired vision 24%, elevated blood lipids (39%) and amputation of toes or feet (2.2%). The average value HbA1C in the group with comorbidity was 8.47% and in the group without comorbidity 6.46%. The subjects with comorbidity had low quality of life assessment in relation to the group without comorbidity: the domain of physical health (45.64 vs 79.66), psychological health (50.3 vs 76.86), social relations (52.97 vs 75.46) and environment (52.7 vs 75.06). Conclusion. Diabetes mellitus type 2 has negative influence on the quality of life. It contributes to the presence of comorbidity. The occurrence of comorbidity was associated with higher glucosylated HbA1C values. There was no difference in the assessment of quality of life regarding gender, age, or the type of therapy used. The quality of life was assessed as low in patients with comorbidity. However, certain personality characteristics play a decisive role in self-evaluation

Autoimunska tireoidna bolest i poliglandularne autoimunske bolesti

Autoimmune polyglandular syndrome (APS) involves dysfunction of two or more endocrine glands, which is based on the autoimmune mechanism. Many authors in addition to the two main APS syndrome, involves the third stand in which autoimmune thyroid disease (ATD) is associated with other autoimmune diseases. APS type 1 occurs less frequently, starting in early childhood and the key is mutation in autoimmune regulator gene. Three major components characterize this syndrome: hypoparathyroidism, autoimmune adrenal insufficiency and mucocutaneous candidiasis. APS type 2 is associated with the HLA antigen system and basically is a disorder of CD4+ and CD25+ regulatory T-cells. The main components of the syndrome are: Addison's disease, ATD and type 1 diabetes mellitus. An important feature of APS is that the expression of components occurs in different time intervals, with each other long periods. ATD is more common than other autoimmune endocrine diseases and include Graves' disease, chronic autoimmune thyroiditis and postpartum thyroiditis. ATD associated with HLA class II genes and polymorphism of cytotoxic T-lymphocytes antigen 4. In basic there is disorder of cellular and humoral immunity, with auto-antibodies targeting tissue specific antigen and and present infiltration of mononuclear cells, predominantly lymphocytes in the affected tissue. The most common antibodies are thyroid peroxidase, thyroglobulin and TSH receptor antibodies. ATD is often associated with other endocrine (diabetes mellitus type 1, Addison's disease, autoimmune pituitary disease, hypoparathyreoidism, premature ovarian failure) and non-endocrine autoimmune diseases. Given the frequency of ATD is a legitimate screening of ATD in other autoimmune diseases, and not vice versa. Testing involves the determination of TPO antibodies and TSH to separate those with high risk of developing ATD and forecasts for further screening

Osteoporosis reversibility in a patient with celiac disease and primary autoimmune hypothyroidism on gluten free diet: A case report

Introduction. Secondary osteoporosis occurs in many diseases. Celiac disease-induced osteoporosis is the consequence of secondary hyperparathyroidism. Biochemical bone markers show predominance of bone resorption, thus making the bisphosphonates the first line therapy option. Intestinal mucosal changes are reversible on gluten-free diet. Osteoporosis reversibility is also possible, provided postmenopausal osteoporosis risk factors independent from celiac disease are not present. Case report. We presented a postmenopausal woman with at least a 10-year history of celiac disease prior to diagnosis, which had overt secondary hyperparathyroidism with insufficient status of vitamin D and a significant bone mass reduction. At the time of diagnosis of celiac disease the patient was receiving 250 g of levothyroxine daily without achieving optimal substitution. Three years after the initiation of gluten-free diet the patient was without any signs and symptoms of the disease. All laboratory findings were within normal range. It was decided to treat the underlying disease and to supplement calcium and vitamin D without the initiation of bisphosponate therapy. Conclusion. Osteoporosis regression justified this therapeutic approach. The presence of primary autoimmune hypothyroidism makes this case specific, since the inability for optimal substitution therapy with a high daily dose of levothyroxine provoked the suspicion of celiac disease

Pituitary abscess with unusual clinical course

The aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of inflammatory markers. The presence of expansile sellar lesion, showing restricted diffusion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confirmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fibrotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic inflammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic inflammatory changes with granulation tissue proliferation, mimicking macroadenoma

Physical activity and bone turnover in women with osteopenia

Background/Aim. Osteoporosis is a systemic disease of the skeleton characterized by a decrease in bone mass and changes in the bone structure. An increased tendency of the bone tissue for fractures occurs as a consequence of these changes. The initial phase of physiological aging of the bones that gradually leads to osteoporosis is osteopenia. This paper tracks the effects of a specific kind of physical exercise program in women with osteopenia. The aim was to quantify the impact of this program on: the concentration of bone metabolism blood markers, muscle strength, aerobic capacity, and physical dimensions. Methods. The sample consisted of 26 women in postmenopause (age 46–58) divided into two groups – experimental group (n = 15) and control group (n = 11). A combined program of exercise consisting of aerobic activities and strength training was applied in the experimental group, while the control group did not join in the exercise program. The program lasted for 7 weeks, three times a week with a break day between the trainings. The intensity of the aerobic training was in the span of 60% to 70% of heart rate reserve (HRR), and the intensity of the strength training was in the span of 60% to 85% of one repetitive maximum (1RM). Osteopenia was diagnosed prior to the experiment by applying a dual energy X-ray absorptiometry of the lumbar spine and the hip. The following was measured before and after the experiment: the level of biochemical markers in the serum [Beta-aspartic acid β-cross laps (CTx), total procollagen type 1 N-terminal peptide (tP1NP) and bone isoenzyme of alkaline phosphatase (ALP), 1RM of leg extensors, maximum oxygen consumption (VO2 max), bodily height and mass, and a calculated Body Mass Index (BMI). Results. Significant changes were determined only in the experimental group. During the experimental period, there was a significant increase of muscle strength and VO2 max, with a decrease of Beta-CTx concentration. No statistically significant changes were recorded in the control group. Conclusion. A 7- week period of systematic exercise showed to be sufficient to increase muscle strength and VO2 max, partially also to decrease bone resorption, but insufficient to alter bone volume, bodily mass, and BMI

The influence of hyperprolactinemia on coagulation parameters in females with prolactinomas

Introduction. Currently there is little information on the effects of prolactin (PRL) on the coagulation and fibrinolytic systems. Objective. The aim of this study was to evaluate the effects of hypeprolactinemia on the parameters of the hemostatic system and activation of the coagulation system. Methods. We studied PRL levels, body mass index (BMI), values of activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), D-dimer level, von Willebrand factor antigen (vWFAg) and fibrinogen in 15 young female patients with microprolactinomas before and after therapy and in 15 healthy female controls. Results. As expected, pretreatment PRL levels were significantly higher in patients than in controls (140.90±42.87 vs. 12.53±4.05 ng/ml; p<0.001). PT, although still in the normal range, was prolonged in patients with hyperprolactinemia as compared to the control group (13.53±1.39 vs. 12.65±0.53 s; p=0.03) and normalized after therapy (12.69±0.65 vs. 12.65±0.53 s; p=0.88). TT, although in normal range, was significantly shorter in the hypeprolactinemic patients than in the controls (14.34±4.52 vs. 17.21±1.35 s; p<0.025) and after treatment remained significantly shorter than in the controls (15.17±1.55 vs. 17.21±1.35 s; p<0.0001). D-dimer values before treatment in the patients with hyperproplactinemia were above the normal range (239.47±107.93 vs. 131.27±50.64 ng/ml, p=0.002) and decreased to normal values after therapy (239.47±107.93 vs. 146.60±39.15 ng/ml; p<0.001). D-dimer levels correlated with PRL (r=0.30) and the change in serum D-dimer values significantly correlated with the change in PRL levels during therapy (r=0.62). aPTT, vWFAg and fibrinogen were similar in patients and controls. Conclusion. In our study, increased thrombin generation that resulted in elevated D-dimer levels may be one of the contributing factors to the prethrombotic state in patients with hyperprolactinemia. [Projekat Ministarstva nauke Republike Srbije, br. 175033 i br. 174016